Timing of warnings emerging as key issue in meningitis lawsuits

Dec. 8, 2013

Written by

Walter F. Roche Jr.

The Tennessean

By the time officials from the Saint Thomas Outpatient Neurological Center called to see how Mary Neal Martin of Inglewood was doing, she was already in the hospital. She died a month later, one of 16 Tennessee patients to succumb in a nationwide fungal meningitis outbreak.

The timing and content of that call and subsequent letters from the outpatient center to potential victims of the outbreak are emerging as key elements in dozens of lawsuits now working their way through the federal courts.

Though it would be months before all the details were known, a review of court filings shows that by the time a detailed warning letter dated Oct. 2, 2012, was sent out by the clinic, three local patients already had died and at least 10 had been hospitalized. Five days earlier, the state Health Department had urged Saint Thomas and two other facilities to contact potential victims right away.

Court filings and interviews show that, in a series of phone calls made to potential victims before the Oct. 2 letter, clinic staffers made no mention of fungal meningitis or its symptoms but merely asked how the patient was doing.

Attorneys for the victims and their survivors say the outpatient center delayed widespread notification, only doing so after state and federal health officials made a formal public announcement of the outbreak on Oct. 1.

The charges of any delay brought a sharp response from one of the attorneys for the clinic.

“Any allegation that the health care providers delayed notification of patients after the discovery of the outbreak or failed to make phone calls as instructed by the state is simply untrue and unsupported by the facts,” Chris J. Tardio wrote in an email response to questions.

Records obtained by the Tennessean show state officials sent out a suggested notification script to the Nashville clinic and two other Tennessee health providers on Sept. 28, four days before the letter dated Oct. 2, which finally arrived in patients’ mailboxes over the next few days.

The state had urged providers to contact patients “as soon as possible, preferably by phone,” according to the records obtained by The Tennessean.

On Sept. 28, and a few days earlier, evidence shows that clinic officials made phone calls to a targeted group of patients, those who got steroid shots on the same days as the victims who had been identified by then.

Tennessee Health Department spokesman Woody Mc­Millin said that in the early days of the outbreak, state officials and the outpatient center staff “discussed the need to contact patients quickly to see if any reported any ill effects.”

He said that on Sept. 24, the state requested the clinic contact patients who got injections on the same days as the known cases. The call to check on Mary Martin came the next day.

The wife of the late Kentucky Judge Eddie Lovelace described a similar experience. By the time clinic staff called Joyce Lovelace on Sept. 25, 2012, her husband already had died. The caller never mentioned meningitis but asked how the judge was doing.

McMillin said the suggested script was sent on Friday, Sept. 28.

The four-paragraph letter from Saint Thomas Outpatient stated it was investigating “several cases of meningitis involving patients ... who received either lumbar or cervical epidural injections at our facility.”

It advised patients to contact the office immediately if they were experiencing symptoms such as high fever, severe headache, stiff neck or sensitivity to light.

State 'script' similar

The proposed “script” sent by the state to the neurosurgical center on Sept. 28 was similar. It indicated some victims might have suffered a stroke or stroke-like symptoms and that one of the victims was found to have meningitis caused by a mold, aspergillus.

C.J. Gideon, the lead attorney for the clinic, said the message was sent out late on a Friday and merely repeated what had been sent to the state by the U.S. Centers for Disease Control and Prevention.

Mark Chalos, an attorney representing victims of the outbreak, said the clinic’s delay in notifying patients raised “serious concerns” and was “one of a series of bad decisions that endangered patients’ safety.”

Robert A. Young, a Kentucky attorney who has filed suit on behalf of several Kentucky victims of the outbreak, said it was particularly troubling that some of those victims were injected on Sept. 20, 2012, the same day the outpatient center was shut down.

”It seems pretty egregious that they had enough knowledge that day to shut the clinic down but still gave injections of the tainted medicine that day,” Young said.

But Tardio, the lawyer representing the clinic, insisted the clinic followed the state’s advice “at every turn.”

“The doctors and nurses at Saint Thomas Outpatient Neurosurgical Center created phone banks and made hundreds of calls to potentially affected patients within days of the discovery of the outbreak at the direction of the Tennessee Department of Health,” he added.

Pat Martin, Mary Neal Martin’s daughter, said the phone call inquiring about how her mother was doing came on Sept. 25. By that time, the 89-year-old woman had been admitted to Skyline Medical Center. She was diagnosed with fungal meningitis the next day.

A review of the nearly 60 pending lawsuits, including the one filed by Pat Martin and her brother Larry, shows that some patients got neither a phone call nor the Oct. 2 letter.

A suit filed on behalf of Cindy Carman of Trousdale states that she finally learned on Oct. 29 that she had a fungal infection, even though she had been to see the doctor who prescribed the steroid injections three times between the time the outbreak became known and that date.